Neuropathy, Peripheral

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Basics

Description

  • A functional or structural disorder of the peripheral nervous system (PNS), affecting any combination of motor, sensory, or autonomic nerves
  • Peripheral motor involvement causes muscle atrophy, weakness, cramps, and fasciculations.
  • Disorders of sensory nerves produce negative phenomena (loss of sensibility, lack of balance) or heightened phenomena (tingling or pain). Large sensory fiber dysfunction impairs touch and vibration sensation, whereas small fiber sensory neuropathy (SFSN) affects pin and thermal sensation and causes neuropathic pain.
  • The autonomic nervous system (ANS) includes the sympathetic and parasympathetic systems. ANS dysfunction causes cardiovascular, gastrointestinal, and sudomotor symptoms.
  • The PNS can be affected from the cell body (sensory ganglionopathy or motor neuronopathy), root (radiculopathy), or plexus (plexopathy) to the nerve (demyelinating or axonal neuropathy).
  • Peripheral neuropathy (PN) can be subdivided as mononeuropathies, multifocal neuropathies, and polyneuropathies.

Epidemiology

Prevalence

  • Prevalence of PN is estimated to be 1% and increases to 7% among people 65 years and older (1).
  • Among adults with diabetes, the prevalence of peripheral neuropathy is estimated to be between 6% and 51%, depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes (2).

Etiology and Pathophysiology

PN occurs due to demyelination or axonal degeneration.

  • 30% of PN cases are idiopathic.
  • The most common cause of acquired PN is diabetes mellitus, which manifests most commonly at approximately 75% in the pattern of a distal sensory polyneuropathy (DSP).
  • Other categories of acquired PN with examples are the following:
    • Vascular: ischemia, vasculitis
    • Infectious: HIV, hepatitis C, cryoglobulinemia, Lyme disease, varicella zoster
    • Traumatic: compression, crush, stretch, or transection (e.g., due to broken or dislocated bones, slipped disks between vertebrae, or arthritis)
    • Autoimmune: rheumatoid arthritis, Sjögren, lupus
    • Metabolic: renal failure, hypothyroidism, vitamin B12 deficiency, celiac disease, porphyria
    • Iatrogenic/toxic: chemotherapy, platinum, taxanes, metronidazole, colchicine, infliximab, lead, alcoholism
    • Neoplastic/paraneoplastic: paraproteinemia, Waldenström macroglobulinemia, multiple myeloma, amyloidosis, neurofibromatosis
  • Acquired polyneuropathies typically present with distal onset of symptoms.

Genetics
Approximately 50% of undiagnosed PN is hereditary.

Risk Factors

Systemic disorders predispose to PN, such as diabetes and alcoholism.

Commonly Associated Conditions

Diabetes, alcoholism, and other conditions related to acquired forms of PN

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Basics

Description

  • A functional or structural disorder of the peripheral nervous system (PNS), affecting any combination of motor, sensory, or autonomic nerves
  • Peripheral motor involvement causes muscle atrophy, weakness, cramps, and fasciculations.
  • Disorders of sensory nerves produce negative phenomena (loss of sensibility, lack of balance) or heightened phenomena (tingling or pain). Large sensory fiber dysfunction impairs touch and vibration sensation, whereas small fiber sensory neuropathy (SFSN) affects pin and thermal sensation and causes neuropathic pain.
  • The autonomic nervous system (ANS) includes the sympathetic and parasympathetic systems. ANS dysfunction causes cardiovascular, gastrointestinal, and sudomotor symptoms.
  • The PNS can be affected from the cell body (sensory ganglionopathy or motor neuronopathy), root (radiculopathy), or plexus (plexopathy) to the nerve (demyelinating or axonal neuropathy).
  • Peripheral neuropathy (PN) can be subdivided as mononeuropathies, multifocal neuropathies, and polyneuropathies.

Epidemiology

Prevalence

  • Prevalence of PN is estimated to be 1% and increases to 7% among people 65 years and older (1).
  • Among adults with diabetes, the prevalence of peripheral neuropathy is estimated to be between 6% and 51%, depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes (2).

Etiology and Pathophysiology

PN occurs due to demyelination or axonal degeneration.

  • 30% of PN cases are idiopathic.
  • The most common cause of acquired PN is diabetes mellitus, which manifests most commonly at approximately 75% in the pattern of a distal sensory polyneuropathy (DSP).
  • Other categories of acquired PN with examples are the following:
    • Vascular: ischemia, vasculitis
    • Infectious: HIV, hepatitis C, cryoglobulinemia, Lyme disease, varicella zoster
    • Traumatic: compression, crush, stretch, or transection (e.g., due to broken or dislocated bones, slipped disks between vertebrae, or arthritis)
    • Autoimmune: rheumatoid arthritis, Sjögren, lupus
    • Metabolic: renal failure, hypothyroidism, vitamin B12 deficiency, celiac disease, porphyria
    • Iatrogenic/toxic: chemotherapy, platinum, taxanes, metronidazole, colchicine, infliximab, lead, alcoholism
    • Neoplastic/paraneoplastic: paraproteinemia, Waldenström macroglobulinemia, multiple myeloma, amyloidosis, neurofibromatosis
  • Acquired polyneuropathies typically present with distal onset of symptoms.

Genetics
Approximately 50% of undiagnosed PN is hereditary.

Risk Factors

Systemic disorders predispose to PN, such as diabetes and alcoholism.

Commonly Associated Conditions

Diabetes, alcoholism, and other conditions related to acquired forms of PN

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